head and facial disorders

Question 1

etiolgy of bell’s palsy

Answer 1

• idiopathic
• might be associated with HSV

Question 2

what conditions increase risk for bell’s palsy

Answer 2

• pregnancy
• diabetes

Question 3

clinical presentation

• sudden onset of unilateral facial paralysis
  
  • inability to close eye
  • facial drooping
  • decreased tearing
  • hyperacusis
  • +/- lost of taste to anterior 2/3 of tongue

Answer 3

• bell’s palsy

Question 4

bell’s palsy

Answer 4

• acute facial nerve palsy
  
  • LMN lesion affecting ipsilateral side of face, involves entire side

Question 5

ramsay hunt syndrome

Answer 5

• cephalic zoster with facial nerve involvement or herpes zoster oticus
  
  • evaluate for vesicles near external meatus

Question 6

what differentiates bell’s palsy symtpoms from lyme disease

Answer 6

• lyme disease can affect facial nerve but typically bilateral involvement lasting less than 2 months

Question 7

how would a central facial palsy (UMN lesion) present

Answer 7

• UMN lesion affects contralateral portion of lower face
  
  • can still raise eyebrows

Question 8

how is bell’s palsy diagnosed

Answer 8

• clinical diagnosis

Question 9

max severity of bell’s palsy should be reached within what time frame

Answer 9

• progressive with max seveity within 3 weeks

Question 10

when should diagnostic studies be considered in assessment of suspected bell’s palsy

Answer 10

• atypical symptoms
• no significant improvement in 4 months
• progression beyong 3 weeks

Question 11

treatment of bell’s palsy

Answer 11

• prednisone x 5-7 days
• +/- valacyclovir
• best results if tx initiated within 3 days of symptoms onset
• artificial tears applied hourly

Question 12

duration of symptoms of bell’s palsy

Answer 12

• majority improve within 3 weeks with normal function returning in 3-6 months
  
  • recurrence rate 7-15%

Question 13

What is Trigeminal Neuralgia?

Answer 13

• recurrent brief episodes of severe, unilateral pain along 5th cranial nerve
  
  • pain is electrical “shock-like” sensation

Question 14

patient population affected in Trigeminal Neuralgia

Answer 14

• W >M
• > 50 yo
• family association rare

Question 15

Trigeminal Neuralgia can be classified into what two groups

Answer 15

• classic: idiopathic or vascular compression of trigeminal nerve root
• painful trigeminal neuropathy (secondary)
  
  • causes: multiple sclerosis

Question 16

in Trigeminal Neuralgia, compression of trigeminal nerve causes

Answer 16

demyelination

Question 17

Trigeminal Neuralgia typically affects what part of 5th cranial nerve

Answer 17

• unilateral
• V2 > V3 > V1
  
  • V1 may be associated with autonomic symptoms

Question 18

tiggers of Trigeminal Neuralgia

Answer 18

• light touch
• chewing, talking, shaving, brushing teeth

Question 19

what is pretrigeminal neuralgia

Answer 19

• continuous, dull ache in jaw prior to classic symptoms of Trigeminal Neuralgia

Question 20

how is Trigeminal Neuralgia diagnosed

Answer 20

• at least 3 paroxysmal episodes of unilateral facial attacks: severe intensity, shock-like pain
• affects trigeminal nerve distribution only
• no neurological deficits

**may need to r/o other causes: MRI/MRA

Question 21

treatment of Trigeminal Neuralgia

Answer 21

• carbamazepine
  
  • +/- Baclofen

Question 22

What is Temporal arteritis

Answer 22

• giant cell arteritis
• chronic vasculitis of large and medium vessels
  
  • wall thickening and decreased lumen

Question 23

Temporal arteritis can lead to what two serious conditions

Answer 23

• ophthalmic artery occlusion: blindness
• basilar artery occlusion: brain stem infarct

Question 24

Temporal arteritis commonly affects what patient population

Answer 24

• > 50 yo
• F>M

Question 25

clinical presentation

• new headache, unilateral, severe
• visual disturbances
• polymyalgia rheumatica
• jaw claudication
• fever

Answer 25

Temporal arteritis

Question 26

physical exam for Temporal arteritis should include

Answer 26

• vision evaluation
• temporal artery palpation: will be tender with decreased or absent pulse
  
  • ausculate for bruits
• check carotid bruits

Question 27

how is Temporal arteritis diagnosed

Answer 27

need 3/5

• ESR > 50 mm/hr
• age of onset > 50 y.o.
• new, localized headache
• temporal artery tenderness, decreased temporal pulse
• temporal artery biopsy​
  
  • 2cm section of artery
    
    • ​presence of multi-nucleated cells” diagnostic

Question 28

treatment of Temporal arteritis

Answer 28

• glucocorticoid treatment - prednisone
  
  • ​high suspicion, start tx prior to confirming dx

Question 29

what is temporomandibular joint dysfunction

Answer 29

• pain associated with TMJ misalignment
  
  • ​muscular hypertrophy with malocclusion
  • arthritis

Question 30

what puts someone at a high risk for temporomandibular joint (TMJ) dysfunction

Answer 30

• rheumatoid arthritis
• ? mood and psychiatric disorder

Question 31

clinical presentation

• periauricular pain and tenderness of TMJ and muscles of mastication
• crepitus of jaw with movement
• decreased jaw ROM

Answer 31

temporomandibular joint dysfunction

Question 32

treatment of temporomandibular joint dysfunction

Answer 32

• NSAIDS, tylenol, TCAs